Job Applicant Employment Verification Form

The person identified below is being considered for employment here at (name of the company) and has signed a statement authorizing this verification and investigation. We shall appreciate a statement of your opinions and experiences as outlined below. Your reply will be considered confidential.

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Name of the Applicant

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Social Security Number

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Dates of Claimed Employment

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Position Last Held

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Final Rate of Pay

Is the above information correct? Yes…… No……..

If not please make corrections.

What is your opinion as to this person’s

Ability……………………Effort…………………….

Conduct……………………Attendance…………………

Reason for leaving your employ…………………………..

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Eligible for retire? Yes…..No…..If not, why?………….

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Your further comments on any personal or professional strength and weaknesses will be really appreciated……………………….